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Hydatid Torsion – Causes, Symptoms and Treatment

Hydatid torsion is the twisting of a small embryonic tissue appendage on the testis or epididymis, causing sudden scrotal pain and affecting mainly children and adolescents.

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Things worth knowing about "Hydatid Torsion"

Hydatid torsion is the twisting of a small embryonic tissue appendage on the testis or epididymis, causing sudden scrotal pain and affecting mainly children and adolescents.

What is Hydatid Torsion?

Hydatid torsion refers to the twisting (torsion) of a small embryonic tissue remnant called a hydatid, located on the testis or epididymis. These appendages are vestigial structures from embryonic development with no known function in adulthood. The most commonly affected structure is the appendix testis (also known as the Morgagni hydatid), while torsion of the appendix epididymidis is less frequent. Hydatid torsion is one of the most common causes of acute scrotal pain in children and adolescents.

Causes and Risk Factors

The exact cause of hydatid torsion is not fully understood. It is believed that the narrow, stalk-like attachment of the hydatid to surrounding tissue allows it to twist spontaneously. Contributing factors may include:

Physical activity or sudden movement
Minor trauma to the genital area
Age: most commonly affects boys between 7 and 14 years (prepubertal period)
Anatomical characteristics such as a long, thin stalk

Unlike testicular torsion (twisting of the entire testicle), hydatid torsion rarely constitutes a surgical emergency, as the blood supply to the testis itself remains unaffected.

Symptoms

Hydatid torsion typically presents with the following signs and symptoms:

Sudden onset of scrotal pain, usually less severe than in testicular torsion
Local swelling and redness of the scrotum
Tenderness at the upper pole of the testis
A small, bluish nodule visible through the scrotal skin, known as the blue dot sign
Mild discomfort when walking or sitting
Nausea or vomiting are uncommon (more typical of testicular torsion)

Diagnosis

Diagnosis is primarily clinical, supported by imaging studies:

Physical examination: Palpation of the testis, identification of a tender nodule at the upper testicular pole, and assessment of the blue dot sign
Color Doppler ultrasound: The most important diagnostic tool to differentiate hydatid torsion from testicular torsion. In hydatid torsion, blood flow to the testis is preserved, and an enlarged, hypoechoic appendage may be visualized.
Differential diagnosis: It is essential to distinguish hydatid torsion from testicular torsion and epididymitis, as testicular torsion requires immediate surgical intervention.

Treatment

Conservative Management

In most cases, hydatid torsion can be managed conservatively, as the condition is self-limiting and the testis itself is not endangered:

Rest and limited physical activity
Scrotal cooling (ice packs)
Pain relief with anti-inflammatory medications (e.g., ibuprofen or paracetamol)
Scrotal support (elevation of the scrotum)

Symptoms typically resolve within 1 to 2 weeks, as the hydatid undergoes necrosis, calcifies, and is reabsorbed by the body.

Surgical Treatment

Surgical removal of the hydatid (resection) is indicated when:

The diagnosis is uncertain and testicular torsion cannot be reliably excluded
Pain persists or worsens despite conservative treatment
Secondary inflammation or complications arise

The procedure is minor and low-risk; the testis itself is not affected.

Prognosis

The prognosis of hydatid torsion is excellent. Since the testis itself is not involved in the torsion, there is no risk to testicular function or fertility. Complete resolution of symptoms occurs in virtually all cases. However, it is important that any acute scrotal pain be evaluated promptly by a physician to rule out the more dangerous condition of testicular torsion.

References

Mattoo TK, Goldstein SL: Torsion of testicular appendages. In: UpToDate, Wolters Kluwer, 2023.
Favorito LA, Cavalcante AG, Costa WS: Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. International braz j urol. 2004;30(2):130-135.
Sharp VJ, Kieran K, Arlen AM: Testicular torsion: diagnosis, evaluation, and management. American Family Physician. 2013;88(12):835-840.

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